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Incidence and Severity of Obstructive Sleep Apnea in One Thousand Twenty Children with Cleft-Craniofacial Conditions
Alexander Y. Lin, MD1, Justine McGauley, BA1, Jeremy A. Goss, BA1, Eric A. Boakye, MA2, Margie S. Hunter, BS1, Paula Buchanan, MPH, PhD2, Shalini Paruthi, MD1.
1Saint Louis University School of Medicine, St. Louis, MO, USA, 2Saint Louis University Center for Outcomes Research, St. Louis, MO, USA.

PURPOSE:
We characterized the degree and severity of obstructive sleep apnea (OSA) among our patients with cleft-craniofacial conditions.
METHODS:
Retrospective review of records from 2009-2014. Patients with polysomnograms (PSG) were included for analysis with descriptive statistics.
RESULTS:
Of 1,020 cleft patient records examined, 92 patients (51.1% male) had clinical symptoms warranting 115 postoperative PSGs. Average PSG age 6.3 years (SD 4.7). 105/115 (91.3%) had OSA defined by obstructive apnea-hypopnea index (OAHI) >1. OAHI histogram performed; ≤1: 10/115 (8.7%); >1, <5: 46/115 (40.0%); ≥5, <10: 30/115 (26.1%); ≥10, <15: 9/115 (7.8%); ≥15, <20: 4/115 (2.5%); ≥20, <25: 6/115 (5.2%); ≥25, <30: 4/115 (3.5%); ≥ 30: 6/115 (5.2%).
Syndromic association was 27/92 (29.4%). Robin sequence in 18/92 (19.6%). Procedures performed before each PSG: primary palatoplasty 11.3% (13/115), secondary speech surgery 31.3% (36/115), tonsillectomy or adenoidectomy 25.2% (29/115), takedown procedures 2.6% (3/115), and other procedures 40.0% (46/115). Median time until postoperative PSG 11.5 months (IQR 6.2-32.2).
CONCLUSION:
Obstructive sleep apnea is a common finding in our patient population, with an incidence near 10%, compared to the published rate of 1-5% in the general pediatric population. The majority of these patients (40%) present with OAHI between 1 and 5. Signs and symptoms of OSA should be elicited and further evaluated in children with cleft-craniofacial conditions.


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